Integration of nutritional support with paediatric HIV care in developing countries

Human immunodeficiency virus (HIV) infection and malnutrition remain major causes of morbidity and mortality among children in developing countries. Malnutrition also exacerbates the clinical course of HIV-infected children by further compromising immunity and increasing the severity of opportunistic infections. This review summarizes current scientific knowledge regarding the role of nutrition in the pathophysiology of HIV infection in children and presents the perspective of integrating nutritional interventions with programmes in resource-limited settings to increase survival of HIV-exposed and -infected children. The three major programming areas for identifying and caring for HIV-infected and HIV-exposed children are: (1) prevention of mother-to-child transmission (PMTCT) of HIV, which is the earliest possible detection of HIV-exposure of the child, (2) care for HIV-infected children and (3) treatment of malnourished children, as for many children whose HIV exposure is unknown, malnutrition can be a first sign of HIV infection. Care for HIV-exposed and -infected infants and children requires early diagnosis of HIV exposure and status, especially through PMTCT services, availability of antiretrovirals (ARVs) and nutritional services including growth monitoring, use of specially formulated foods, micronutrient supplementation, vitamin A supplementation, zinc therapy and micronutrient supplementation for the treatment of diarrhoea, use of iodized salt and exclusive breastfeeding according to national guidelines. Given that the scale-up of PMTCT is expected to accelerate in the next several years, basic nutritional interventions should be part of the standard of care of these programmes.